Long-term efficacy and safety of baricitinib in patients with severe alopecia areata: 104-week results from BRAVE-AA1 and BRAVE-AA2

BACKGROUND

Efficacy of the Janus kinase (JAK) inhibitor baricitinib for severe alopecia areata (AA) continuously increased over 52 weeks in two Phase 3 trials. There are limited long-term data on JAK inhibitors in AA.

OBJECTIVES

To evaluate efficacy and safety of baricitinib for severe AA through 104 weeks of continuous therapy.

METHODS

Integrated data from the BRAVE-AA1 and BRAVE-AA2 Phase 3 trials included adults with Severity of Alopecia Tool (SALT) scores ≥50 (≥50% scalp hair loss) randomized to and continuously treated with 2-mg or 4-mg baricitinib through Week 104. Patients who qualified to remain on continuous treatment included subjects who achieved SALT score ≤20 at Week 52 (Week-52 responders; 2-mg: N = 65; 4-mg: N = 129) and baricitinib 4-mg-treated patients who had SALT score >20 at Week 52 but achieved SALT score ≤20 at prior visit(s) and/or had significant improvement in eyebrow or eyelash hair growth relative to baseline by Week 52 (Week-52 mixed responders; N = 110). Week-104 outcomes included the proportion of patients achieving SALT score ≤20 (≤20% scalp hair loss). Data were censored after treatment discontinuation.

RESULTS

Among baricitinib 4-mg-treated and baricitinib 2-mg-treated Week-52 responders, 90.7% and 89.2%, respectively, maintained SALT score ≤20 at Week 104. Among Week-52 mixed responders, 39.1% reached SALT score ≤20 by Week 104. Continued improvement in eyebrow and eyelash regrowth was observed across groups. The most frequent treatment-emergent adverse events were COVID-19, upper respiratory tract infection, headache, nasopharyngitis, acne, urinary tract infection and creatine phosphokinase increase.

CONCLUSIONS

Baricitinib demonstrated a high level of maintenance of efficacy over 104 weeks in patients with severe AA. Efficacy increased in Week-52 mixed responders, illustrating that long-term treatment is necessary to observe maximum benefit in some patients. No new safety signals were observed.

Addressing HPSP Learner Needs: A Pilot Study of a "Fundamentals of Military Medicine" Course

INTRODUCTION

Military medicine is uniquely different from civilian medicine, and military physicians in the USA are primarily recruited through the Health Professions Scholarship Program (HPSP) and the Uniformed Services University of the Health Sciences (USUHS). Medical students at the USUHS receive more than 650 hours of military-specific curriculum and spend 21 days engaged in field exercises. HPSP students complete two 4-week officer training sessions during their 4 years of medical school. There is a clear discrepancy in preparation for military medicine between HPSP and USUHS students. The USUHS School of Medicine undertook an initiative to develop a fully online self-paced course on the fundamentals of military medicine topics to help HPSP students bridge the gap in their preparation. This article will describe how the online self-paced course was designed and present feedback from the pilot offering of this course.

MATERIALS AND METHODS

As proof of concept of the effectiveness of an online self-paced course for teaching the fundamentals of military medicine to HPSP students, two chapters from the "Fundamentals of Military Medicine" published by the Borden Institute were transferred to an online format. Each chapter was offered as a module. In addition to the chapters, an introduction and closing module were added to the pilot course. The pilot course was offered over 6 weeks. Data for this study were obtained from module feedback surveys, pre- and post-course quizzes, participant focus groups, and course evaluation surveys. Pre- and post-test scores were analyzed to evaluate content knowledge. The open-ended survey questions on the feedback forms and focus group transcripts were collated and analyzed as textual data.

RESULTS

Fifty-six volunteers enrolled in the study, and 42 completed the pre- and post-course quizzes. This participant pool included HPSP students (79%, n = 44) and military residents in civilian graduate medical education programs (21%, n = 12). The module feedback surveys showed that most participants spent 1 to 3 hours on each of the modules, which they rated as extremely or quite reasonable (Module 1: 64%, Module 2: 86%, Module 3: 83%). There was not much difference between the overall quality of the three modules. The participants found content on application to the military-specific context very valuable. Of the different course elements, video content was rated as the most effective. Participant feedback clearly highlighted that HPSP students want a course that informs them about the fundamentals of military medicine and demonstrates how the information would apply to their lives. Overall, the course was effective. HPSP students showed knowledge gains and self-reported satisfaction with the course's objectives. They were able to locate information easily and understand the course expectations.

CONCLUSIONS

This pilot study has shown that there is a need for a course that provides the fundamentals of military medicine to HPSP students. A fully online self-paced course provides flexibility for the students and improves access.

Large language models and agricultural extension services

Several factors have traditionally hampered the effectiveness of agricultural extension services, including limited institutional capacity and reach. Here we assess the potential of large language models (LLMs), specifically Generative Pre-trained Transformer (GPT), to transform agricultural extension. We focus on the ability of LLMs to simplify scientific knowledge and provide personalized, location-specific and data-driven agricultural recommendations. We emphasize shortcomings of this technology, informed by real-life testing of GPT to generate technical advice for Nigerian cassava farmers. To ensure a safe and responsible dissemination of LLM functionality across farming worldwide, we propose an idealized LLM design process with human experts in the loop.

Stereotactic Cardiac Ablative Radiotherapy (SCAR) for Refractory Ventricular Tachycardia: Western Australia Experience

PURPOSE/OBJECTIVE(S)

Ventricular tachycardia is a potentially life-threatening cardiac condition that is associated with significant morbidity and mortality. Despite advances in medical therapies, implantable cardioverter-defibrillator (ICD) and catheter ablative therapy (CAT), some patients continue to suffer recurrent VT. SCAR is a highly accurate, non-invasive, and novel ablative therapeutic option that has shown promising results in the treatment of refractory VT patients associated with structural heart disease. Early case series and subsequent prospective clinical trials have demonstrated SCAR to be well-tolerated with acceptable safety profiles and consistently decreased VT episodes in VT patients, who failed all conventional antiarrhythmic medications and CAT. The aim of the current study is to report the efficacy and safety/tolerability of SCAR in ICD-dependent patients with refractory VT in Western Australia, Australia.

MATERIALS/METHODS

Seven patients with recurrent refractory VT, deemed high risk or non-suitable for CAT, were referred to GenesisCare at Fiona Stanley Hospital, Western Australia for SCAR between July 2020 and November 2022. Target volume definition and delineation involved interdisciplinary teams by combining all available clinical, electrophysiological mapping and diagnostic/planning cardiac imaging data to generate radiotherapy plans. Patients were treated whilst awake, with a single dose of 25 Gy using VMAT technique on the Synergy Linac with stereotactic X-ray tool capability. Efficacy was assessed by counting the number of episodes of VT and ICD shocks after SCAR. Safety and tolerability were evaluated by treatment related toxicities during follow up.

RESULTS

Of the seven patients referred for SCAR, only five received SCAR as two patients died from their refractory VT before their radiotherapy. For the patients receiving SCAR with at least 6 months follow-up, overall reduction in VT episodes and ICD shocks was 95% and 85%, respectively. No significant treatment-related toxicities were documented during follow-up. Two patients had died. Neither of their deaths were directly attributed to their radiotherapy. One patient died after requesting to cease her antiarrhythmic medications and to have her ICD switched off 2 days after SCAR (against medical advice). The other patient died 431 days after SCAR from aspiration pneumonia after fracturing her cervical spine following a fall at home and was unrelated to her VT.

CONCLUSION

Our data reflects international experience in terms of treatment efficacy and safety profiles of SCAR for patients with refractory VT. SCAR is increasingly recognized as an alternative cardiac ablative option for ICD-dependent VT patients who failed all conventional antiarrhythmic treatments. Nonetheless, careful patient selection and longer-term follow-up are required to ensure the optimal treatment outcomes can be achieved in these patients.

A Rare Case of Severe Burn Injury to the Oropharynx Caused by a Flare Gun

Flare gun injuries are rare, and patients often present with complex trauma that may require multiple operative interventions. Our objective is to explore a case of a 15-year-old male, who presented with second-degree flame burns to the face, left upper extremity and bilateral hands, as well as third-degree burns to the oropharynx and a tongue laceration after a flare gun was discharged into his mouth. The patient underwent multiple debridements of the oral cavity and oropharynx, and his hospital course was complicated by an intra-oral abscess. He eventually made a full recovery and was discharged. This case not only illustrates the need for early operative intervention, but it also underscores the need for awareness campaigns that highlight the dangers of flare guns and similar devices.

Evaluating a Competency-Based Blended Health Professions Education Program: A Programmatic Approach

INTRODUCTION

Competency-based education (CBE) programs usually evaluate student learning outcomes at a course level. However, a more comprehensive evaluation of student achievement of competencies requires evaluation at a programmatic level across all courses. There is currently insufficient literature on accomplishing this type of evaluation. In this article, we present an evaluation strategy adopted by the competency-based master's degree program at the Center for Health Professions Education at the Uniformed Services University of Health Sciences to assess student achievement of competencies. We hypothesized that (1) learners would grow in the competencies through their time in the program and (2) learners would exhibit a behavioristic change as a result of their participation in the program.

MATERIALS AND METHODS

The degree program at the Center for Health Professions Education conducts an annual student self-assessment of competencies using a competency survey. The competency survey data from graduated master's students were collected, providing data from three time points: initial (pre-program survey), middle, and final (end-of-program survey). Open-ended responses from these three surveys were also analyzed. A general linear model for repeated measures was conducted. Significant effects were followed by post hoc tests across time. We also conducted post hoc analysis across domains to better understand the comparative levels of the domains at each time point. The responses to the open-ended prompt were thematically analyzed.

RESULTS

Analysis of the quantitative data revealed that (1) learners reported significant growth across time, (2) learners had different perceptions of their competencies in each of the domains, and (3) not all domains experienced similar changes over time. Analysis of the free responses highlighted the impact of coursework on competency attainment and the behavioristic change in learners.

CONCLUSIONS

This study presents a strategic evaluation tool for course-based CBE programs that follow a traditional credit hour model. Programmatic evaluation of CBE programs should enable the inclusion of the learner's voice and provide evaluation data that go beyond individual course evaluations.

Supporting the Transition to Distance Education During the Pandemic and Beyond

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic affected almost every country around the world, and various forms of lockdown or quarantine measures were implemented. The lockdowns forced medical educators to step beyond traditional educational approaches and adopt distance education technologies to maintain continuity in the curriculum. This article presents selected strategies implemented by the Distance Learning Lab (DLL) at the Uniformed Services University of Health Sciences (USU), School of Medicine (SOM), in transitioning their instruction to an emergency distance education format during the COVID-19 pandemic.

MATERIALS AND METHODS

When moving programs/courses to a distance education format, it is important to recognize that two primary stakeholders are involved in the process: faculty members and students. Therefore, to be successful in transitioning to distance education, strategies must address the needs of both groups and provide support and resources for both.The DLL used two lenses of adult learning and targeted needs assessment to design faculty and student support during the pandemic. The DLL adopted a learner-centered approach to education, focusing on meeting the faculty members and students where they are. This translated into three specific support strategies for faculty: (1) workshops, (2) individualized support, and (3) just-in-time self-paced support. For students, DLL faculty members conducted orientation sessions and provided just-in-time self-paced support.

RESULTS

The DLL has conducted 440 consultations and 120 workshops for faculty members since March 2020, serving 626 faculty members (above 70% of SOM faculty members locally) at USU. In addition, the faculty support website has had 633 visitors and 3,455 pageviews. Feedback comments provided by faculty members have specifically highlighted the personalized approach and the active, participatory elements of the workshops and consultations.Evaluations of the student orientation sessions showed that they felt more confident in using the technologies after the orientation. The biggest increase in confidence levels was seen in the topic areas and technology tools unfamiliar to them. However, even for tools that students were familiar with before the orientation, there was an increase in confidence ratings.

CONCLUSION

Post-pandemic, the potential to use distance education remains. It is important to have support units that recognize and cater to the singular needs of medical faculty members and students as they continue to use distance technologies to facilitate student learning.

The APPD Longitudinal Educational Assessment Research Network's First Decade

ABSTRACT

In 2009, the Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), a national educational research network, was formed. We report on evaluation of the network after 10 years of operation by reviewing program context, input, processes, and products to measure its progress in performing educational research that advances training of future pediatricians. Historical changes in medical education shaped the initial development of the network. APPD LEARN now includes 74% (148 of 201) of US Pediatric residency programs and has recently incorporated a network of Pediatric subspecialty fellowship programs. At the time of this evaluation, APPD LEARN had approved 19 member-initiated studies and 14 interorganizational studies, resulting in 23 peer-reviewed publications, numerous presentations, and 7 archived sharable data sets. Most publications focused on how and when interventions work rather than whether they work, had high scores for reporting rigor, and included organizational and objective performance outcomes. Member program representatives had positive perceptions of APPD LEARN's success, with most highly valuing participation in research that impacts training, access to expertise, and the ability to make authorship contributions for presentations and publication. Areas for development and improvement identified in the evaluation include adopting a formal research prioritization process, infrastructure changes to support educational research that includes patient data, and expanding educational outreach within and outside the network. APPD LEARN and similar networks contribute to high-rigor research in pediatric education that can lead to improvements in training and thereby the health care of children.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

Investigating dilution ventilation control strategies in a modern U.S. school bus in the context of the COVID-19 pandemic

Fresh air ventilation has been identified as a widely accepted engineering control effective at diluting air contaminants in enclosed environments. The goal of this study was to evaluate the effects of selected ventilation measures on air change rates in school buses. Air changes per hour (ACH) of outside air were measured using a well-established carbon dioxide (CO₂) tracer gas decay method. Ventilation was assessed while stationary and while traversing standardized route during late autumn/winter months in Colorado. Seven CO₂ sensors located at the driver's seat and at passenger seats in the front, middle, and rear of the bus yielded similar and consistent measurements. Buses exhibited little air exchange in the absence of ventilation (ACH = 0.13 when stationary; ACH = 1.85 when mobile). Operating the windshield defroster to introduce fresh outside air increased ACH by approximately 0.5-1 ACH during mobile and stationary phases. During the mobile phase (average speed of 23 miles per hour (mph)), the combination of the defroster and two open ceiling hatches (with a powered fan on the rear hatch) yielded an ACH of approximately 9.3 ACH. A mobile phase ACH of 12.4 was achieved by the combination of the defroster, ceiling hatches, and six passenger windows open 2 inches in the middle area of the bus. A maximum mobile phase ACH of 22.1 was observed by using the defroster, open ceiling hatches, driver window open 4 inches, and every other passenger window open 2 inches. For reference, ACHs recommended in patient care settings where patients are being treated for airborne infectious diseases range from 6 to ≥12 ACHs. The results indicate that practical ventilation protocols on school buses can achieve air change rates thought to be capable of reducing airborne viral transmission to the bus driver and student passengers during the COVID-19 pandemic.

Timing of Vaccine Decision-Making Among First-Time Parents

OBJECTIVE

Decreased childhood vaccination can lead to local outbreaks of vaccine-preventable disease. In a pilot study from our group, 72% of parents of newborns reported initiating their vaccine decision-making for that child prior to conception. Since a sound understanding of the timing of parental vaccine decision-making is needed to direct educational efforts, we surveyed a national cohort of first-time parents to extend our preliminary findings.

METHODS

From March 2019 to March 2020, first-time parents of newborns in mother-baby units of the Better Outcomes through Research for Newborns (BORN) network completed the Vaccine Preference Development Survey (VPDS). The VPDS measures intent to vaccinate, timing of vaccine decision-making, and sources of influence. Univariate and multivariate analyses explored associations between intent to vaccinate and timing of vaccine decision-making with demographic variables.

RESULTS

Twenty-three sites provided surveys through site-specific nonrandom systemic sampling; 91% (1393/1524) of surveys were used in the analysis. Most parents planned to fully vaccinate (1191/1380, 86.3%) and started vaccine decision-making prior to conception (850/1378, 61.7%). Maternal age, race and ethnicity, relationship status, and education were all significantly associated with planning to fully vaccinate and preconception decision-making (P < .001). Preconception decision-making correlated strongly with intent to fully vaccinate (P < .001). Parents influenced by personal education, medical professionals, and family/friends were more likely to endorse preconception decision-making; those strongly influenced by internet/social media were less likely to allow all vaccines or start decision-making prior to conception.

CONCLUSIONS

Vaccine decision-making occurs preconception for most new parents. Initiating vaccine discussions during the birth hospitalization may be too late.

Perceived acceptability of partial enteral nutrition (PEN) using oral nutritional supplement drinks in adolescent and adult Crohn's disease outpatients: A feasibility study

BACKGROUND AND AIMS

Studies, mainly in Japanese cohorts, have shown that partial enteral nutrition (PEN) including oral nutritional supplement (ONS) drinks can prolong disease remission and increase drug effectiveness in Crohn's disease (CD). Acceptability is a key feasibility parameter to determine whether PEN is a viable treatment option in UK CD patients. We report the results of a single centre cross-sectional feasibility study carried out to investigate perceived acceptability of PEN using ONS drinks and whether ONS preference varies with sex, nutritional status or phenylthiocarbamide (PTC) sensitivity.

METHODS

Patients with a confirmed CD diagnosis were recruited using convenience sampling from an adult and adolescent gastroenterology outpatient clinic over 3 years. Blind taste testing of 5 polymeric ONS drinks were conducted using a validated 9-point hedonic rating scale followed by completion of an acceptability questionnaire based on the preferred ONS drink. A subset of patients took home the preferred ONS drink for a 7-day ONS study.

RESULTS

105 CD patients (55 males), aged 34.9 (±15.4) years were recruited and 28 patients completed the 7-day ONS study. Overall impression scores did not significantly vary with nutritional status, sex, BMI, handgrip strength (HGS), mid-upper arm circumference (MUAC) or PTC sensitivity. Ensure plus milkshake™ rated highest for overall impression (6.5, p=<0.0001) and all other organoleptic properties (p < 0.0001). The main perceived benefits of using ONS drinks as PEN related to assurance of nutrient intake (89%), convenience (86%), and improvement of gut symptoms (85%). The main perceived barriers related to reduction in pleasure from eating and drinking (56%), struggling with drink storage (54%) having less energy and feeling more tired than if eating 3 solid meals daily (52%). 65% of patients would consider using ONS drinks as PEN as a maintenance treatment option. 81% of patients felt confident-very confident about consuming ONS drinks daily as PEN for three months but this dropped to 64% and 37% at 6 and 12 months, respectively. There was a significant drop in perceived ease of use of ONS drinks as PEN after the 7-day ONS study (P = 0.01).

CONCLUSION

Use of ONS drinks as PEN have high perceived benefits and appear to be a feasible option for short-term use of 3-6 months in CD patients. However, confidence in long-term use of ONS drinks as PEN is low mainly due to the perceived social impact. Future studies should assess longer trial periods and volume of ONS drinks to increase the validity of these findings.

Parenthood and Parental Leave Decisions in Pediatric Residency

OBJECTIVES

The demands of residency training may impact trainees' decision to have children. We examined characteristics of pediatric residents' decisions regarding childbearing, determinants of resident parental leave, and associations with well-being.

METHODS

A survey of 845 pediatric residents at 13 programs was conducted between October 2019 and May 2020. Survey items included demographics, desire for future children, and logistics of parental leave. Outcomes included parental leave length, burnout and depression screening results, satisfaction with duration of breastfeeding, and satisfaction with parental leave and parenthood decisions.

RESULTS

Seventy-six percent (639 of 845) of residents responded to the survey. Fifty-two percent (330) of respondents reported delaying having children during residency, and 29% (97) of those were dissatisfied with their decision to do so. Busy work schedule (89.7%), finances (50.9%), and a desire not to extend residency (41.2%) were the most common reasons for delay. Of respondents, 16% were parents and 4% were pregnant or had pregnant partners. Sixty-one parental leaves were reported, and 67% of parents reported dissatisfaction with leave length. The most frequently self-reported determinant of leave duration was the desire not to extend residency training (74%). Program mean leave length was negatively associated with burnout, measured as a dichotomous outcome (odds ratio = 0.81 [95% confidence interval 0.68-0.98]; P = .02).

CONCLUSIONS

Many pediatric trainees delay parenthood during residency and are not satisfied with their decision to do so. Pediatric resident parental leave remains short and variable in duration, despite the positive association between longer leaves and overall well-being.

The experience of older persons with mental health conditions who interact with healthcare robots and nurse intermediaries: The qualitative case studies

Background

Caring expressions between humans and nonhuman intelligent machines are futuristic prototypes with healthcare robots as major advocates.

Objective

To examine the experience of older persons with mental health conditions, particularly patients with schizophrenia and with dementia in the interaction with healthcare robots and intermediaries in a transactive relational engagement.

Methods

Two qualitative case studies were conducted using sophisticated audio-video technologies to record the conversation and activities that were carefully documented. Following the procedure for qualitative descriptive analysis, a framework based on the Transactive Relationship Theory of Nursing was employed to analyze and interpret the data.

Results

Three themes were revealed, including feelings for the other, inspiring meaningful responses, and demonstrating expressions of joy. The description of the experience of older persons involved in the conversation with humanoid robots was feeling for the other while inspiring meaningful responses in demonstrating expressions of joy.

Conclusion

This study provided initial evidence that the transactive engagements of robots with older persons with schizophrenia and dementia and nurse intermediaries in psychiatric and mental health settings can result in occasions of 'joy' for the patients. These findings suggest that transactive engagements with robots facilitate expressions of joy among older persons with schizophrenia and dementia. However, these findings are not intended to prescribe nursing care actions but to describe the experience of older persons who are in transactive engagements with intelligent machines, indicating the importance and value of healthcare robots in nursing older persons with schizophrenia and with dementia.

Classical Resummation and Breakdown of Strong-Field QED

QED perturbation theory has been conjectured to break down in sufficiently strong backgrounds, obstructing the analysis of strong-field physics. We show that the breakdown occurs even in classical electrodynamics, at lower field strengths than previously considered, and that it may be cured by resummation. As a consequence, an analogous resummation is required in QED. A detailed investigation shows, for a range of observables, that unitarity removes diagrams previously believed to be responsible for the breakdown of QED perturbation theory.

Psychiatric Emergencies: Emergency Department Management of Altered Mental Status

In the United States, encounters related to mental and substance use disorders are common in emergency departments (EDs). Altered mental status (AMS) is a frequent presentation seen in EDs across the country. Individuals may present to the ED with altered thought processes, which may be attributed to intoxication from substances and/or psychoses, conditions that require immediate care and management. Health care providers must always ascertain the etiology of AMS, which may be challenging owing to the various causes of this impairment. The current article provides an overview of the most common disorders associated with AMS, which include underlying medical conditions, substance use, and mental disorders. [Journal of Psychosocial Nursing and Mental Health Services, 59(9), 16-25.].